Provider Demographics
NPI:1669665642
Name:PICCOLI, LORIE GAITHER (MD)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:GAITHER
Last Name:PICCOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:ANN
Other - Last Name:GAITHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2450
Mailing Address - Fax:717-851-3469
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2450
Practice Address - Fax:717-851-3469
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449617207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2979080OtherHIGHMARK BLUE SHIELD
PA102850732Medicaid
PA790550OtherUPMC
PA102850732Medicaid
PA313196EZ3Medicare PIN